On Wednesday, the State Health Benefits Program (SHBP) Plan Design Committee met for its regularly scheduled monthly meeting. Items on the agenda included a High Deductible Plan Discussion, Reduced Specialty Copay resolution, discussion of the cost implications of not adopting continuing resolutions for Plan Year 2024, subgroup updates, Horizon Telehealth briefing, follow up on the Super Conciliator meeting, and discussion about the AON Plan Design Comparison report. There was no discussion of Plan Year 2024 cost increases in advance of the State Health Benefits Commission (SHBC) Rate Renewal Meeting in July.
High Deductible Plans and Resolution 2023-1
The committee adopted resolution 2023-1 Reduced Specialty Copay for Plan Year 2023 to remain compliant with Centers for Medicare & Medicaid Services (CMS). The committee discussed the value of high deductible plans, given their limited enrollment and similar available plans. They will explore whether there is value in continuing to make this plan available in future years.
Cost Implications of Non-Renewal of Continuing Resolutions
For Plan Year 2024, there was discussion as to the cost implications of not renewing continuing resolutions including:
- Resolution 2023-5 Formulary Management and Out of Network Physical Therapy
- Resolution 2023-6 Mail Order Incentive and $0 Copay for Generic Mail Order Prescription Drugs
- Resolution 2023-7 Generic Substitution Preference
- Resolution 2023-8 Copay Reduction for Retiree Mail Order Preferred Brand Prescription Drugs
- Resolution 2023-9 Tiered Network Plan Financial Incentive Pilot Program
- Resolution 2023-10 Reduced Specialty Copay
The conclusion is that not adopting the resolutions for Plan Year 2024 would increase rates by 5% for local government employees, 5.5% for local government early retirees, 4.5% for state government employees, and 5.5% for state early retirees.
Both subgroup reports from Medical Specialty Pharmaceuticals and Reference Based Pricing noted that while each are exploring cost-saving options for future plan years, for a variety of reasons including state procurement rules, it is unlikely to establish any cost-saving options soon.
Horizon Telehealth Report
The committee heard from Horizon on the benefits of the Telehealth program that is available to enrollees. The presenters were not able to share any information regarding the cost savings for telehealth utilization compared to urgent care. Visiting urgent care has been cited as a large utilization cost driver.
AON Plan Design Comparison Report Discussion
The final agenda item was discussion of the AON Plan Design Comparison Report and concerns about the fact that not all Plan Design Committee members had the ability to review the report before it was transmitted to the Legislature by the Department of Treasury.
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Contact: Paul Penna, Senior Legislative Analyst, email@example.com, 609-695-3481, x110.